21/34. Giant cavernoma of the brain stem: value of delayed MR imaging after contrast injection.Cavernous angiomas are vascular malformations composed of slowly perfused, sinusoidal vessels which can be located in any part of the central nervous system. Whereas diagnosis is mostly straightforward in typical cases, some lesions may present in unusual locations or with unusual imaging characteristics. Because of the slow perfusion, contrast enhancement is not regarded as a characteristic imaging feature of cavernomas. We report a large brain stem cavernoma with signs of recent bleeding, in which the differential diagnosis against other mass lesions was facilitated by the demonstration of slow, but intense, contrast enhancement on MRI 1 h after contrast injection. We conclude that contrast enhancement in delayed images may contribute to a safe diagnosis of cavernous haemangiomas and should be performed in atypical cases.- - - - - - - - - - ranking = 1keywords = brain stem, brain (Clic here for more details about this article) |
22/34. Development of a complex dural arteriovenous fistula next to a cerebellar developmental venous anomaly after resection of a brainstem cavernoma. Case report and review of the literature.Developmental venous anomalies (DVAs) are common abnormalities of intracranial venous drainage, which may occur in conjunction with other cerebral vascular malformations and are known for their benign natural history. The authors present the case of a 16-year-old boy who experienced a spontaneous brainstem hemorrhage due to a cavernoma. Preoperative angiography findings revealed a large DVA draining the right cerebellar hemisphere. The patient underwent suboccipital surgery for cavernoma resection and recovered completely from his neurological symptoms. Fourteen months later he returned with progressive symptoms. Repeated angiography demonstrated a complex dural arteriovenous fistula (DAVF) of the transverse sinus, which had developed next to the DVA. Several transarterial and transvenous embolizations were ineffective. Common causes of acquired DAVFs and the potential role of the DVA in the development of the DAVF in this case are discussed on the basis of the pertinent literature.- - - - - - - - - - ranking = 2.4002405E-5keywords = brain (Clic here for more details about this article) |
23/34. Can small lesions induce language reorganization as large lesions do?Shift of the cortical mechanisms of language from the usually dominant left to the non-dominant right hemisphere has been demonstrated in the presence of large brain lesions. Here, we report a similar phenomenon in a patient with a cavernoma over the anterolateral superior temporal gyrus associated with epilepsy. language mapping was performed by two complementary procedures, magnetoencephalography, and electrocorticography. The maps, indicated right temporal lobe dominance for receptive language and left frontal lobe dominance for expressive language. These results indicate that a small lesion, associated with epilepsy, may produce selective shifting of receptive language mechanisms as large lesions have been known to produce.- - - - - - - - - - ranking = 4.800481E-6keywords = brain (Clic here for more details about this article) |
24/34. Metastatic low-grade inflammatory myofibroblastic tumor (IMT) in the central nervous system of a 29-year-old male patient.A case of myofibrosarcoma (IMT) of the brain and lung as well as the spinal cord is described. A 29-year-old male patient presented with fever (40 degrees C), malaise, vomitus, meningism and leukocytosis. Computer tomography identified a bleeding in the left frontal lobe. A bleeding angioma was suspected and an operation was performed. The histological examination could not reveal an exact diagnosis. Eight months after complete recovery from the first bleeding, the patient had a second intracranial temporo-occipital bleeding on the right side which has been removed operatively. A new lesion was seen in the left parietal white matter of the brain. A growing cavernoma was suspected and resection of the lesion was planned. Pre-operatively the patient suffered from hemoptysis and fever. The X-ray of the chest showed a pulmonary lesion in the left lower lobe. In the CT of the chest a large tumor in the left lower lobe of the lung and additionally a cystic structure in the mediastinum was seen. The histological examination of this tumor identified an inflammatory myofibroblastic tumor (IMT). The left parietal lesion has been resected after the thoracic operation. The brain lesions were estimated to be metastases of the IMT of the lung. In the further clinical history the patient developed a large spinal cord metastasis of the thoracic spine. The metastatic development of the tumor reported in this case is unusual. The current therapy of these tumors consists of complete tumor resection and further clinical controls. However, due to the localization and the extension of some lesions in the present case, the complete resection has not been possible. There is no proven role of chemotherapy and radiation therapy. The patient died due to the pulmonary deterioration.- - - - - - - - - - ranking = 1.4401443E-5keywords = brain (Clic here for more details about this article) |
25/34. Successful resection of a left insular cavernous angioma using neuronavigation and intraoperative language mapping.Despite recent literature advocating the surgical removal of symptomatic Cavernous Angiomas (CA), even in critical brain areas, very few observations of insular CA surgery have been described, particularly in the left hemisphere. We report the case of a successful resection of a CA located in the dominant insula, using both neuronavigation and intra-operative functional mapping. This 33-year-old right-handed man harbored a left insular CA, revealed by generalized seizures following a bleed confirmed on MRI. The preoperative examination was normal. A stereotactic-guided surgery was performed under local anesthesia, with intra-operative functional mapping using direct cortico-subcortical electrical stimulation in the awake patient--allowing the surgeon to achieve total resection of both CA and pericavernomatous gliosis, as shown on repeated postoperative MRIs. There was no postsurgical deficit, nor any seizure without treatment (follow-up: 4.5 years). The diagnosis of CA was confirmed by histological examination. Taking account of the risk of morbidity due to the natural history of CA, particularly in eloquent brain regions, we suggest to routinely consider the possibility of a surgical treatment in cases of symptomatic (left dominant) insular CA, using combined intra-operative anatomical and physiological localization methods.- - - - - - - - - - ranking = 9.600962E-6keywords = brain (Clic here for more details about this article) |
26/34. A brainstem cavernoma demonstrating a dramatic, spontaneous decrease in size during follow-up: case report and review of the literature.BACKGROUND: Many reports have demonstrated a worse prognosis for patients whose cavernomas were subtotally removed than for those whose cavernomas were not surgically treated. Therefore, it is better not to touch the cavernoma if a surgeon is not prepared to totally remove it. This report describes a large brainstem cavernoma showing a spontaneous, dramatic reduction in size after removal of only the biopsy specimen of the lesion. CASE DESCRIPTION: A 42-year-old woman experienced facial numbness, diplopia, and ataxia. A magnetic resonance (MR) study revealed a pontine cavernoma with hemorrhage. Two weeks later, recurrence of the patient's symptoms and consciousness disturbance were noted. An MR study revealed massive hemorrhage from the cavernoma with a ventricle dilatation. An operation on the lesion was conducted 3 months after the initial hemorrhage. However, the operation was aborted when an exploration of the lesion showed a tight adhesion between the lesion and the pons. Removal of only a biopsy specimen and evacuation of the suckable hematoma were done. No neurologic recovery and no decrease in the size of the cavernoma were detected postoperatively. Her family did not wish for further treatments. She was in a bedridden state with severe brainstem dysfunction when she was transferred to a local hospital. Sixteen months after the surgery, her consciousness was clear, and MR imaging confirmed a marked reduction in the size of the cavernoma. CONCLUSION: A dramatic, spontaneous decrease in size does occur even in the case of a large brainstem cavernoma showing hemorrhages. Conservative therapy may be one of the treatment options for the symptomatic brainstem cavernoma.- - - - - - - - - - ranking = 3.8403848E-5keywords = brain (Clic here for more details about this article) |
27/34. Intraoperative motor mapping of the cerebral peduncle during resection of a midbrain cavernous malformation: technical case report.OBJECTIVE AND IMPORTANCE: Brainstem cavernous malformations that seem to come to a pial or ependymal surface on preoperative magnetic resonance imaging studies may, in fact, be covered by an intact layer of neural tissue. For cavernous malformations in the cerebral peduncle, intraoperative stimulation mapping with a miniaturized probe can determine whether this overlying tissue harbors fibers in the corticospinal tract. In addition, intermittent monitoring with transcranial motor evoked potentials (TcMEPs) helps to protect this vital pathway during resection of the lesion. CLINICAL PRESENTATION: A 20-year-old woman collapsed after a cavernous malformation in the left cerebral peduncle hemorrhaged into the pons, midbrain, and thalamus. She presented with right hemiparesis and left oculomotor palsy. INTERVENTION: The cavernous malformation was completely resected through a left orbitozygomatic craniotomy and transsylvian approach. Stimulation mapping of the cerebral peduncle with a Kartush probe (Medtronic Xomed, Inc., Jacksonville, FL) identified the corticospinal tract lateral to the lesion, and a layer of tissue over the lesion harbored no motor fibers. TcMEP monitoring helped to guide the resection, with increased voltage thresholds and altered waveform morphologies indicating transient impaired motor conduction. All TcMEP changes returned to baseline by the end of the procedure, and the patient's hemiparesis improved after surgery. CONCLUSION: Stimulation mapping of the corticospinal tract and intermittent TcMEPs is a safe and simple surgical adjunct. Expanded monitoring of the motor pathway during the resection of cerebral peduncle cavernous malformations may improve the safety of these operations.- - - - - - - - - - ranking = 2.4002405E-5keywords = brain (Clic here for more details about this article) |
28/34. Value of gradient-echo magnetic resonance imaging in the diagnosis of familial cerebral cavernous malformation.BACKGROUND: Cerebral cavernous malformations (CCMs) are congenital vascular anomalies that can cause seizures, intracranial hemorrhages, focal neurological deficits, and migrainelike headaches. Magnetic resonance (MR) imaging has substantially facilitated diagnosis of CCM. It is now widely accepted that familial clustering with an autosomal dominant inheritance pattern should be suspected in cases of multiple lesions. OBJECTIVE: To determine by MR imaging the penetrance of cavernous malformations in a 3-generation family that included 5 members with typical clinical signs and diagnostic findings. methods: All family members underwent routine MR T1-weighted and T2-weighted spin-echo sequences in addition to MR T2-weighted gradient-echo sequences. RESULTS: Four family members had been symptomatic with either brainstem bleeding, headaches, or focal neurological signs. The gradient-echo sequences yielded a dramatically higher sensitivity with regard to lesion number and distribution.As in previous reports of familial CCM, an increase in lesion number with increasing age, changes in lesion characteristics, de novo occurrence in serial MR imaging over time, and the phenomenon of anticipation could be confirmed in this family. CONCLUSION: Magnetic resonance gradient-echo sequences should be considered the method of choice for diagnosis of familial CCM.- - - - - - - - - - ranking = 4.800481E-6keywords = brain (Clic here for more details about this article) |
29/34. Unusual locations for cavernous hemangiomas: report of two cases and review of the literature.Cavernous hemangiomas are most commonly found within the subcortical neural parenchyma near the fissura Rolandi, in the basal ganglia, or in the brain stem. Because of advancing neuro-imaging technology and thus resulting in a higher incidence of cavernous hemangiomas they have rising impact in neurosurgery. We present two unusual cases of extra-axial cavernous hemangiomas: one located at the frontal falx, the other within the bone of the right frontal bone. We discuss these and other cases in the literature with respect to the more common differential diagnoses and the appropriate therapy regimen for cavernous hemangiomas in these locations.- - - - - - - - - - ranking = 1keywords = brain stem, brain (Clic here for more details about this article) |
30/34. Papillary glioneuronal tumor radiologically mimicking a cavernous hemangioma with hemorrhagic onset.Papillary glioneuronal tumor is a recently identified low-grade brain neoplasm classified as variant of ganglioglioma. Its salient morphological characteristics are the presence of pseudopapillary structures composed of blood vessels, often hyalinized, lined by uniform small astrocytes and a proliferation of neurocytic cells, eventually admixed with ganglioid and ganglion cells. We present a case of papillary glioneuronal tumor occurring in a 15-year-old female with an unusual hemorrhagic onset. The clinical, morphological and immunohistochemical features are discussed and the published literature is reviewed. This article proposes that papillary glioneuronal tumor should be included in the differential diagnosis of patients with tumoral related brain hemorrhage.- - - - - - - - - - ranking = 9.600962E-6keywords = brain (Clic here for more details about this article) |
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